Associations of Long-Term Blood Pressure Burden and Variability With Kidney Function Decline.

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Epidemiology

Background:

• Single blood pressure (BP) measurements may not fully reflect kidney damage.
• Long-term BP burden and visit-to-visit variability are potential indicators of hemodynamic stress on kidneys.
• Limited evidence exists on these BP metrics and kidney function decline in the general population.

Purpose of the Study:

• To investigate the association between long-term BP burden and visit-to-visit BP variability with kidney function decline.
• To analyze the impact of cumulative BP exposure on estimated glomerular filtration rate (eGFR) slope and incident chronic kidney disease (CKD).

Main Methods:

• Analysis of 2,821 adults with preserved kidney function from a prospective cohort study.
• Derivation of cumulative BP exposure and visit-to-visit BP variability from baseline and follow-up measurements.
• Assessment of annual eGFR slope and study-defined incident CKD as outcomes.

Main Results:

• Higher long-term BP exposure, particularly systolic BP (SBP), correlated with faster kidney function decline.
• A 1-SD increase in cumulative SBP was linked to a more negative annual eGFR slope (β≈-0.15 to -0.18 mL/min/1.73 m²/year).
• Cumulative SBP independently predicted incident CKD (HR 1.45; 95% CI 1.15-1.83); associations for diastolic BP and BP variability were weaker.

Conclusions:

• Long-term BP burden, especially cumulative SBP, is associated with accelerated kidney function decline in the general population.
• Cumulative SBP is a significant predictor of both eGFR decline and incident CKD.
• Findings highlight the importance of sustained BP control for kidney health preservation.